von Schrottenberg Christoph, Deeg Susanne, Weiss Christel, Adam Rüdiger, Wessel Lucas M, Boettcher Michael, Zahn Katrin B
Department of Pediatric Surgery, University Hospital Mannheim, University of Heidelberg, 68167 Mannheim, Germany.
Department of Medical Statistics and Biomathematics, Medical Faculty Mannheim, University of Heidelberg, 68167 Mannheim, Germany.
Children (Basel). 2022 Jul 29;9(8):1137. doi: 10.3390/children9081137.
One potential comorbidity after congenital diaphragmatic hernia (CDH) is gastroesophageal reflux (GER), which can have a substantial effect on patients' quality of life, thriving, and complications later in life. Efforts have been made to reduce gastroesophageal reflux with a preventive anti-reflux procedure at the time of CDH repair. In this follow-up study of neonates participating in a primary RCT study on preventive anti-reflux surgery, symptoms of GER were assessed longitudinally. Long-term data with a median follow-up time of ten years was available in 66 patients. Thirty-one neonates received an initial fundoplication. Secondary anti-reflux surgery was necessary in 18% and only in patients with large defects. It was required significantly more often in patients with intrathoracic herniation of liver ( = 0.015) and stomach ( = 0.019) and patch repair ( = 0.03). Liver herniation was the only independent risk factor identified in multivariate regression analysis. Primary fundopexy and hemifundoplication did not reveal a protective effect regarding the occurrence of GER symptoms, the need for secondary antireflux surgery or the gain of body weight regardless of defect size neither in the short nor in the long term. Symptoms of GER must be assessed carefully especially in children with large defects, as these are prone to require secondary anti-reflux surgery in the long-term. Routine evaluation of GER including endoscopy and impedance measurement should be recommended especially for high-risk patients.
先天性膈疝（CDH）术后的一种潜在合并症是胃食管反流（GER），它会对患者的生活质量、生长发育以及日后生活中的并发症产生重大影响。人们已努力在修复CDH时通过预防性抗反流手术来减少胃食管反流。在这项针对参与预防性抗反流手术的初级随机对照试验研究的新生儿的随访研究中，对GER症状进行了纵向评估。66例患者可获得中位随访时间为10年的长期数据。31例新生儿接受了初次胃底折叠术。二次抗反流手术的必要性为18%，且仅见于大缺损患者。肝（P = 0.015）和胃（P = 0.019）胸腔内疝出以及补片修补（P = 0.03）的患者中二次抗反流手术的需求明显更多。肝疝出是多因素回归分析中唯一确定的独立危险因素。无论缺损大小，初次胃底固定术和半胃底折叠术在短期和长期内均未显示出对GER症状的发生、二次抗反流手术的需求或体重增加有保护作用。必须仔细评估GER症状，尤其是大缺损患儿，因为这些患儿长期来看容易需要二次抗反流手术。对于高危患者，尤其应建议进行包括内镜检查和阻抗测量在内的GER常规评估。
